Addendum to Supporting Statement - 0960-0644

Addendum to the Supporting Statement for

The Ticket to Work and Self-Sufficiency Program

20 CFR 411

OMB No. 0960-0644

Revisions to the ICR:

SSA is making the following changes to this ICR:

• The request for certification of work and educational progress is a new reporting requirement (20 CFR 411.200(b)) for service providers who contract with us under the program. To effectively collect this information we have created the new form SSA-1375 along with two cover letters, the SSA-L1373 and SSA-L1374 which are the initial letter and follow up request respectively. The SSA-1375, Progress Review Form, will request earnings information, educational information, or a combination of the two in order to satisfy the requirement for certification of work and educational progress. (program change +5,175 hours)

• State, local and tribal government service providers must now report when they close a VR case since the Ticket may be assigned to an employment network afterwards as per 20 CFR 411.535(a)(1)(iii) of the Code of Federal Regulations. (program change +709 hours)

• Also, during a periodic review of our information collections, SSA noted that there were two collections for the Ticket to Work and Self-Sufficiency Program: one for the regulations and one for Form SSA-1365. In order to decrease redundancy in our collections, SSA is combining the Ticket to Work regulations (OMB Control No. 0960-0644) with the ICR for the SSA-1365 (OMB Control No. 0960-0641). (adjustment +1,259 hours)

In reviewing the SSA-1365, SSA is making the following revisions to the Form:

• We are revising the Instructions at the top of page 1 as follows:

• We are adding the words “under an EN payment system” to the end of the first sentence.

• We are adding the sentence “This form must be accompanied by the 18-month prior earnings look-back information.” before the second to last sentence (“The ticket holder or his/her representative…etc.”).

• We are enlarging the block in #3 to increase writing space for the Ticket Holder Number.

• We are enlarging the block in #4a to increase writing space for the vocational objective/employment outcome.

• We are adding a checkbox in #4b for “Other.”

• We are removing the current #7 and replacing it with the following:

7. Please describe the services and supports to be provided to the beneficiary to accomplish the vocational goal in 4 above and help the beneficiary’s progress toward self-sufficiency:

1. Service during initial job acquisition and retention phase, i.e. services you plan to complete by the time the Phase 1, Milestone 4 payment is requested

(9 months of work attained).

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b. Other services during ongoing support phases.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

• We are updating the PRA Statement.

Also, the ICR for the SSA-1365, OMB Control No. 0960-0641 contained a Term of Clearance:

Terms of Clearance for 0960-0641:

Approved consistent with memo dated 08/31/2005.

SSA has included this memo with the ICR as a supplementary document. We provided the answers to the questions therein to OMB on 8/31/2005, and OMB approved the ICR per the answers to those additional questions.

Along with the submission of this ICR, SSA is submitting a Discontinuation Request to remove the individual collection for the SSA-1365 (0960-0641). Upon approval of this ICR (0960-0644), SSA will submit the above mentioned forms to SSA’s Forms Management Team for standardization and formatting.